CommercialPrior AuthHigh impact
Hip Preservation Surgery (CPB 0736, reviewed 2026-07-31)
Aetna·Orthopedics, Sports Medicine, General Surgery·Surgery
Effective date
Jul 31, 2026
We identified it
Aug 16, 2026
Summary
Aetna has updated its Hip Preservation Surgery policy (CPB 0736) effective 2026-07-31, establishing strict medical necessity criteria for femoro-acetabular surgery, hip arthroscopy, and pelvic osteotomy. The policy requires documented labral pathology with imaging confirmation, 12 weeks of conservative treatment (including 6+ weeks formal in-person physical therapy), positive impingement signs, and absence of advanced osteoarthritis before surgery is covered. Multiple procedures including diagnostic hip arthroscopy, labral reconstruction, and various adjunctive procedures are classified as experimental/unproven and will not be covered.
Action Required
By 2026-07-31, billing team must: (1) Update billing software to require prior authorization for all hip preservation surgery codes (29860, 29862, 29914, 29915, 29916, 27146, 27147, 27151); (2) Create pre-authorization checklist requiring: imaging reports showing labral pathology with specific measurements (alpha angle >50°, LCEA <20°, or center edge angle ≥40°), documentation of 12+ weeks conservative treatment with minimum 6 weeks formal in-person physical therapy notes, positive impingement sign documentation, and pre-operative imaging confirming absence of Tonnis grade 2+ osteoarthritis and joint space ≥2mm; (3) Flag and deny claims for CPT 29860 (diagnostic arthroscopy) performed without radiologically proven pathology, CPT 29862 (debridement) as isolated procedure, and experimental procedures (labral reconstruction, capsular plication, osteochondral mosaicplasty, ligamentum teres repair); (4) Update provider encounter templates to document all required criteria; (5) Train billing staff that claims lacking complete medical necessity documentation will be denied. Providers must submit imaging reports with measurements and 12-week conservative treatment records with actual PT notes in claims.